摘要: |
[目的]探讨腹腔镜在不孕症合并子宫内膜异位症患者中的诊疗价值。[方法] 回顾性分析了经腹腔镜诊治子宫内膜异位症且为不孕症的49例患者的诊疗结果。包括不同期别内异症的发生情况、输卵管情况、术后妊娠情况。[结果] 因不孕症而行腹腔镜诊治的患者中确诊为内异症的有49例,占48.5%;参照美国生育协会分类方法将所有病例分为三组,Ⅰ、Ⅱ期组内异症组患者输卵管通畅者占95.6%,其输卵管通畅率明显高于Ⅲ期组及Ⅳ 期组,差异有统计学意义(P<0.05);Ⅲ、Ⅳ 期者至少一侧输卵管阻塞的发生率分别为47.4%、71.4%,明显高于Ⅰ、Ⅱ期组,其差异有统计学意义(P<0.05)。随诊6~36个月,21例术后自然受孕,妊娠率为42.9%。其中,Ⅰ、Ⅱ期内异症妊娠11例,Ⅲ期内异症妊娠8例,Ⅳ 期内异症妊娠2例;其余两组妊娠率均高于Ⅳ 期内异症组,差异均有统计学意义(P<0.05)。术后12个月内有17例妊娠,术后12个月以后4例妊娠,其差异有统计学意义(P<0.05)。[结论] ①因不孕症而行腹腔镜诊治的患者中确诊为内异症的发生率有上升的趋势,在微型、轻型内异症患者中输卵管管腔多通畅。②腹腔镜治疗与内异症有关的不孕是有效的治疗方法,尤其是对于非重型患者的治疗。③为增加术后妊娠几率,应使内异症不孕患者在尽量短的时间里妊娠。 |
关键词: 不孕症 子宫内膜异位症 腹腔镜 |
DOI:10.11724/jdmu.2009.06.15 |
分类号:R711 |
基金项目: |
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Laparoscopy in diagnosis and treatment of patients with infertility and endometriosis in 49 cases |
FU Juan, SHI Hong, HUANG Xiang-yan
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Department of Obstetrics and Gynecology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
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Abstract: |
[Objective] To evaluate laparoscopy in the diagnosis and treatment in female infertility and endometriosis. [Methods] The clinic data of 49 patients with infertility and endometriosis diagnosed and treated by laparoscopy were reviewed retrospectively. Data analysis included staging of endometriosis, tubal patency rate, pregnant outcome after operation. [Results] ① The incidence rate of infertility and endometriosis was 48.5% (49/101). Patients were divided into three groups after checking,according to the R-AFS staging for endometriosis. The first was stage Ⅰ and Ⅱ group. The second was stage Ⅲ group. The third was stage Ⅳ group. The bilateral tubal patency rate was 95.6% in stage Ⅰ and Ⅱ group. They were significantly higher than that of stage Ⅲ group and stage Ⅳ group respectively (P<0.05). At least,Unilateral tubal occlusion rate was 47.4% in stage Ⅲ group and 71.4% in stage Ⅳ group. They were significantly higher than that of stage Ⅰ and Ⅱ group respectively (P<0.05). ② Following-up for 6~36 months indicated that there were 21 cases of conception and pregnant rate was 42.9%. Eleven cases were in stage Ⅰ and Ⅱ group, 8 cases were in stage Ⅲ group and 2 cases were in stage Ⅳ group, The pregnant rate of stage Ⅳ group was significantly lower than that of stage Ⅰ and Ⅱ and Ⅲ groups respectively (P<0.05). Following-up for 12 months demonstrated that there were 17 cases of conception. Following-up for 36 months showed there were 4 cases of conception. The difference was significant (P<0.05). [Conclusion]
① The prevalence of endometriosis in infertile women diagnosed by laparoscopy has an increased tendency. Patients of stage Ⅰ and Ⅱ endometriosis often have two patent fallopian tubes. ② Laparoscopy is effective for infertility and endometriosis patients, especially for stage Ⅰ,Ⅱ and Ⅲ patients. ③ To have a good pregnant outcome, patients should conceive as soon as possible. Doctor also can recommend couples to achieve pregnancy with assisted reproductive technique. |
Key words: infertility endometriosis laparoscopy |